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Economic Evaluations of Remote Patient Monitoring for Chronic Disease: A Systematic Review

Published:January 11, 2022DOI:https://doi.org/10.1016/j.jval.2021.12.001

      Highlights

      • Remote patient monitoring (RPM) can be effective in preventing escalation to acute care and has the potential to improve chronic disease management. There has also been a renewed interest in the cost-effectiveness of RPM since the onset of the coronavirus (COVID-19) pandemic. The cost and outcome evidence for RPM has been summarized for some disease-specific contexts (eg, heart failure); however, there are no existing summaries of the available health economic evidence of noninvasive RPM for chronic disease management.
      • This systematic review identified and summarized 34 articles that conducted economic evaluations of noninvasive RPM compared with usual care for chronic disease management. This review demonstrated that RPM can be cost-effective for chronic disease management, although the cost-effectiveness is dependent on capital investment, clinical context, willingness-to-pay thresholds, and the organizational processes involved in RPM implementation and provision.
      • Overarching health economic evidence of RPM is useful for decision makers that are contemplating RPM investment choices for chronic disease management. Compared with usual care, RPM was highly cost-effective for hypertension, where greater cost savings may be achieved in the long term because of prevention of high-cost health events. For chronic obstructive pulmonary disease and heart failure, cost-effectiveness findings often differed according to disease severity. There was limited evidence for the cost-effectiveness of RPM for diabetes and other chronic diseases.

      Abstract

      Objectives

      This study aimed to systematically review and summarize economic evaluations of noninvasive remote patient monitoring (RPM) for chronic diseases compared with usual care.

      Methods

      A systematic literature search identified economic evaluations of RPM for chronic diseases, compared with usual care. Searches of PubMed, Embase, CINAHL, and EconLit using keyword synonyms for RPM and economics identified articles published from up until September 2021. Title, abstract, and full-text reviews were conducted. Data extraction of study characteristics and health economic findings was performed. Article reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist.

      Results

      This review demonstrated that the cost-effectiveness of RPM was dependent on clinical context, capital investment, organizational processes, and willingness to pay in each specific setting. RPM was found to be highly cost-effective for hypertension and may be cost-effective for heart failure and chronic obstructive pulmonary disease. There were few studies that investigated RPM for diabetes or other chronic diseases. Studies were of high reporting quality, with an average Consolidated Health Economic Evaluation Reporting Standards score of 81%. Of the final 34 included studies, most were conducted from the healthcare system perspective. Eighteen studies used cost-utility analysis, 4 used cost-effectiveness analysis, 2 combined cost-utility analysis and a cost-effectiveness analysis, 1 used cost-consequence analysis, 1 used cost-benefit analysis, and 8 used cost-minimization analysis.

      Conclusions

      RPM was highly cost-effective for hypertension and may achieve greater long-term cost savings from the prevention of high-cost health events. For chronic obstructive pulmonary disease and heart failure, cost-effectiveness findings differed according to disease severity and there was limited economic evidence for diabetes interventions.

      Keywords

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